Steamboat Springs School District has collaborated with Northwest Colorado Health to bring a mobile dental clinic to our school and community.  The purpose of this survey is to understand your family’s current dental needs, your interest in accessing the mobile clinic, and additional medical or mental health needs you might want us to address in the future.

The dental mobile clinic brings services to students increasing access to dental services, reducing time off work for parents, addressing transportation and childcare needs and reducing missed classroom time.  All students will have access to services, regardless of their insurance status or ability to pay.

Dental services initially offered will include the following with the option to expand services:  medical history review, screenings and/or exams, radiographs/x-rays, dental charting, fluoride treatments, dental cleanings, referrals to community dentists and oral hygiene instruction and nutritional counseling.

Question Title

* 1. Which school(s) do your children(ren) currently attend?

Question Title

* 2. Which grade do your children under currently attend?

Question Title

* 3. What is the primary language spoken at home?

Question Title

* 4. Have you been told by a doctor that your children have any of the following health problems? Check all that apply.

Question Title

* 5. Have any of your children had these issues in the past year serious enough to need a doctor or dentist? Check all that apply.

Question Title

* 6. When was the last time one of your children saw a healthcare provider?

  Never More than 3 years ago 1-3 years ago In the last year
Saw a dentist for a routine cleaning
Saw a dentist for a cavity or other problem
Saw a doctor for a routine check up
Saw a doctor because of illness
Saw someone for counseling

Question Title

* 7. Where do your children usually receive dental care?

Question Title

* 8. If your child needed to go to the dentist, would you have any of these issues? Check all that apply.

Question Title

* 9. If there was a mobile dental clinic on your child’s school campus, would your child(ren) go there for dental care? 

Question Title

* 10. Would you allow your child(ren) to access the mobile dental clinic under these circumstances?

Question Title

* 11. If we can provide these services in the future, which would you want your children to use at a school-based health center? Check all that apply.

Question Title

* 12. When would you prefer to have healthcare appointments for your children at the mobile dental clinic? Rank the options from 1-3. 1 = most convenient and 3 = least convenient.

Question Title

* 13. Do you have dental insurance for your children?

Question Title

* 14. Do you have any comments or concerns about a mobile dental clinic opening at your children’s school?

0 of 14 answered
 

T